Page 159 - 80_01

Dry
eye
disease
compounds…

developed
to
occlude
the
lacrimal
puncta
and
they
can
be
absorbable
and
non-­-
absorbable
(18).
These
devices
keep
tears
longer
on
the
ocular
surface
relieving

the
patient’s
from
the
undesirable
symptoms.
Other
type
of
treatment
is
the

moisture
chamber
spectacles.
It
has
been
reported
that
increased
periocular

humidity
can
cause
the
tear
film
lipid
layer
to
thicken
and
that
spectacle
wearers

with
dry
eye
have
a
longer
inter-­-blink
interval
than
the
non-­-spectacle
wearers

(19).
Current
treatments
are
mainly
focused
on
addressing
inflammation
and
tear

restoration
(20).
Dry
eye
disease
is
the
outcome
of
many
factors
resulting
in

inflammation
of
cornea
and
conjunctiva.
The
dysfunction
of
the
tear
secretory

glands
leads
to
changes
in
tear
composition
such
as
hyper-­-osmolarity
which

stimulates
the
production
of
inflammatory
mediators
on
the
ocular
surface.
This

inflammation
can
be
initiated
either
by
chronic
irritative
stress
like
wearing

contact
lens
wearing
or
from
a
systemic
inflammatory
autoimmune
disease
like

rheumatoid
arthritis
(21,
22).
Anti-­-inflammatory
drugs
are
widely
used
for
the

treatment
of
the
inflammation
produced
by
diseases.
Topical
corticosteroids
can

relieve
moderate
or
severe
dry
eye
symptoms
and
signs
rapidly
and
effectively

(23).
Steroids
on
the
other
hand
may
cause
severe
side
effects
after
prolonged
use.

The
undesired
effects
vary
from
bacterial
or
fungal
infection,
elevated
intraocular

pressure
and
cataract
formation.
Additionally,
steroids
suppress
locally
the

immune
response
in
patients
with
already
compromised
ocular
surface.
Therefore,

steroids
are
typically
used
only
for
a
limited
period
of
time
in
dry
eye
patients
(20).

Due
to
the
above-­-mentioned
reasons,
non-­-steroidal
anti-­-inflammatory
drugs

(NSAID)
credited
as
causing
less
severe
side
effects
are
recently
evaluated
as
a

potential
dry
eye
treatment.
The
NSAIDs
could
decrease
inflammation
and
eye

discomfort
due
to
their
analgesic
effect,
but
they
might
induce
DED
decreasing

sensitivity.
In
2002
U.S.
Food
and
Drug
Administration
(FDA)
approved
the
drug

RESTASIS®
of
the
company
Allergan
as
the
first
prescription
medicine
capable
to

increase
tear
production
(24).
Topical
RESTASIS®
is
an
ophthalmic
emulsion

containing
cyclosporine
0.05%.
Other
types
of
drug
used
are
the
antibiotics
like

azithromycin,
and
tetracycline.
Furthermore,
some
research
groups
are
studying

the
use
of
serum
tears
and
the
intense
pulse
light
as
potential
treatments
(20).
On

the
following
pages,
we
present
some
future
treatments
currently
passing
clinical

trials.

AL-­-2178/RIMEXOLONE

AL-­-2178/Rimexolone
1%
(Figure
2)
is
a
glucocorticoid
steroid
developed

by
Alcon,
as
a
treatment
for
dry
eye
disease.
Rimexolone
inhibits
T-­-cell

155